Opmaak 1 - VNG International

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solve the problem the person concerned could appear before a court. But this may take a long time. Normally the overseer writes a report to the health inspector and in collaboration with the members of the Womens’ Forum and neighbourhood committee he then makes best efforts to solve the problem. One overseer is located at the landfill to see to it that waste is dumped according to the rules that have been made for sustainable and safe storage of waste, including hazardous waste from hospitals and laboratories. HEALTH SERVICES Health services are supplied by government at all levels. Hospitals in Gedaref are the responsibility of the state government. The health centres and a large number of health inspectors and overseers on the other hand, answer to the locality. Ministry of Health and health centres* The hospitals in Gedaref locality supply second-line healthcare. This is the responsibility of the state. The ministry of health supports all citizens free of charge through the hospitals, irrespective of whether they are rich or poor. However, since the majority of the population is poor, and they are also the ones frequenting the hospitals and health centres, most medical services are in fact supplied to these poor. Though hospitals mainly perform as a curative health institution, they are also involved in training nurses. The home visitors training programme is also used in the hospital training programme. One important issue is hazardous waste. The hospital produces a large amount of such waste that must be disposed of properly, otherwise forming a health threat to the community. The twinning project now supports the creation of a system to responsibly collect and store this waste. Another reason that health services are predominantly supplied to the poor is that some diseases are largely found specifically in the poor areas of the locality. The most significant ones are kala-azar (lichmania) caused by the sand fly, malaria, TBC, and increasingly HIV/AIDS. This last is the result of the location of Gedaref, bordering Ethiopia and Eritrea where more than twenty percent of the population is said to be infected. HIV/AIDS is finally receiving recognition from politicians. Services are allocated freely, and include condoms, testing, counselling, treatment, and surveillance. First line health services in the neighbourhoods are provided by the neighbourhood health centres. Gedaref locality has fifteen such centres. They are involved in curative and preventive health care, but also in extension services for nutrition and prevention at home. Home visitors working in the health centres also have a role in preventive health care. The monitoring of diseases is also done through the health centres in the various neighbourhoods. In ten health centres the number of patients with malaria, diarrhoea, dysentery and trachoma is collected daily and a monthly report is made. The Solid Waste Corporation collects the data in order to be able to give feedback to measure improvements and problems in the different neighbourhoods. Thus was a reduction of malaria patients between 2001 and 2006 recorded of sixty three percent. The ministry has a separate department for preventive health responsible for policy development, recruitment of staff, capacity building, and procurement of tools and insecticide for the localities. Equipment is distributed freely such as impregnated mosquito nets, and indoor and outdoor sprayings are freely supplied. It also organizes health education on endemic diseases. All operational work for this is carried out by the health centres. Another department in the ministry deals with environmental health, such as water safety and sanitation, including latrines. Since many endemic diseases are water-borne this department receives special attention. 32
The actual home visits in the neighbourhoods are not made by staff of the ministry itself but by the home visitors. The Ministry of Health has a health education department that is engaged in training medical staff at the health clinics and all other health related institutions. Staff at the hospitals and health centres make use of the training programmes of the Fontys Hogeschool in Eindhoven. These programmes were originally made for the training of home visitors. There are as yet not many programmes or training courses on preventive health care in Sudan. Health Inspection of Health Department* In terms of prevention an important section of the Health Department is Health Inspection. This has a total of six health inspectors and thirty-five health overseers. Health assistants take the health department further into the neighbourhood, and as such they provide a feedback function. The city is divided into fourteen sectors, each supervised by several overseers who live in that sector. In case of a problem they must try to solve it, but if not able to do so they report to the health inspector. Health overseers have the task to identify irregularities at neighbourhood level concerning health affairs, such as those concerning food served in restaurants, and potential breeding areas for the malaria mosquito. Family Planning Association & Family Planning Clinic A national family planning association was first created in Sudan in 1969. The most important local agent of the association is the family planning clinic in Gedaref locality. The association has an important position in the total health network of the state. It has outgrown its original family planning mandate of downsizing the number of children per family. Its present mandate goes far beyond that. It is based on the so-called five As: Adolescence, Advocacy, Abortion, Access and AIDS. The clinic explicitly delivers services to the poorest people in the form of pre-natal and post-natal care, and child care (vaccinations and treatment). For its services it makes use of the medical infrastructure of government through its health centres in the neighbourhoods. It also has one mobile clinic for treatment and prevention especially for rural people, and it intends to set up another four. The current (mobile) clinic is presently treating 3,500 patients per month. Family planning workers* The medical staff of the family planning association and family planning clinic has an explicit health preventive function, as well as verification function concerning pre and postnatal care. As its staff is specialized in handling sensitive issues, such as sexuality and sexual behaviour, they are directly acquainted with many of the constraints and conflicts in the neighbourhoods. They report to the clinic and association in the centre of the city. EDUCATION SERVICES As with the health sector, service delivery in the education sector takes place at all levels. The university and seven colleges in Gedaref locality answer to the central government, the twenty high schools are the responsibility of the state government, and primary educational institutions are the responsibility of the local government. The local Education Department is responsible for the public schools, while there is also a significant number of private schools. About twelve percent of the schools, serving about six percent of the children, are private. Families with children in private schools are usually not described as poor. Education Department Gedaref locality In Gedaref municipality about 40,000 children (the number of boys and girls is almost equal) are in the primary school age range of six to fourteen years. For their education there are 87 public schools (separate for boys and girls) for which the Education Department is 33
Page 1 and 2: SATIE VOOR INTERNATIONALE ERKING VA
Page 3 and 4: VNG International committed to stre
Page 5 and 6: Table of contents Introduction 5 Ma
Page 7 and 8: Introduction Municipal services suc
Page 9: Routes of accountability, participa
Page 12 and 13: Photo: at a drinking water pump sta
Page 14 and 15: How the poor can influence provider
Page 16 and 17: It argued that education is about m
Page 18 and 19: Without fees, they can be hard to e
Page 20 and 21: My impression is that voters are sl
Page 23 and 24: Case: Accountability in Gedaref Sud
Page 25 and 26: The total budget of Gedaref localit
Page 27 and 28: Gedaref Governmental institutions N
Page 29 and 30: The corporation therefore runs at a
Page 31 and 32: so that defaulters can be taken to
Page 33: The Womens’ Forum mentioned above
Page 37 and 38: esponsible. It also has the mandate
Page 39 and 40: y disseminating information on maln
Page 41 and 42: • The number of pupils in basic e
Page 43 and 44: Figure 3 is how things work in Geda
Page 45 and 46: Attitude, possibility of comparison
Page 47 and 48: their children to another school if
Page 49: VNG International International Co-

Opmaak 1 - VNG International

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